| NPI | 1255522876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0071767) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02003507A) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2024-05-01 |